Before continuing, please note that this article contains very graphic images
Oral and Maxillofacial Surgery is a unique specialty that brings together medicine and dentistry. Its uniqueness in combining these fields makes it one of the most competitive and rewarding specialties that exist.
The extensive range of services provided by Oral and Maxillofacial Surgeons, as well as the drastic changes in the form and function of patients, makes it a very worthwhile career.
The length of training to become an OMFS varies from 10 to 14 years (including dental and medical schools), depending on the degrees awarded and the subspecialty training.
Like any other surgical residency, training in Oral and Maxillofacial Surgery is demanding. Night shifts and being on call at any hour of the day are major challenges.
A hierarchical structure is a crucial part of surgical training:
Level 1: Medical Student
Level 2: Intern
Level 3: Resident
Level 4: Fellow (optional)
Level 5: Attending Physician
This hierarchical structure brings another challenge to the residency. People who cannot handle negative feedback and a stressful environment might feel discouraged initially. So, candidates who enter the residency must bear in mind that the training is tough.
The hierarchical structure of training is not new in medicine. Medical education has historically been characterized by a master-apprentice relationship. Sir William Osler was the one who developed the idea of residency (specialty training) and the pyramidal structure it encompasses in the early 20th century at Johns Hopkins Hospital.
Also, for Oral and Maxillofacial Surgery, this system survives today in most teaching hospitals. As a junior resident, you are exposed to oral surgery, which includes teeth extractions and simple trauma cases. Being in charge of dental students and interns is also a duty of junior residents. Senior residents handle most of the complex tasks such as orthognathic surgery and major trauma cases. The seniors and so-called “attendings” are responsible for the clinical competence of juniors. Your responsibilities grow as you gain experience and earn seniority.
Being an operator in the operating room is the most satisfying thing you can imagine. Generally, during surgery, you can enter the psychological state called “flow”, in which a person performing some activity is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity. This creates a sensation that time is standing still, removing any feeling of fatigue which can occur when one is standing for hours performing an operation.
As a Maxillofacial and Oral Surgeon, no day is ever boring, and no two patients are alike. Working with people’s mouths while they are still conscious most of the time is tough. But as you get into the field and start gaining responsibilities along the way, the enjoyment grows exponentially, similar to the stress levels. As a unique surgical specialty, its scope of practice ranges from simple tooth extractions and implant surgery to head/neck cancer surgery with microvascular reconstructions. Sedative procedures—local and general anesthesia—are an essential part of the training in most countries.
Oral Surgery
Wisdom Teeth Extraction is an oral surgical intervention where the surgeon removes teeth that cannot erupt properly. These are referred to as impacted teeth. Its complexity varies depending on the type of impaction.
Implant surgery is a straightforward surgical procedure designed to restore oral form and function following tooth extractions. Patients dissatisfied with their removable dentures can opt for fixed prostheses, with implants serving as replacements for their natural teeth.
Implants require a certain level of bone density to ensure they do not come loose. Patients with insufficient bone density for implant treatment may require advanced bone augmentation procedures, such as grafting and sinus floor elevation.
Maxillofacial Surgery
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Mandibular reconstruction with a vascularized fibula flap (skin taken from the calf part of the leg) is a procedure to restore lost tissues after the removal of benign tumors and malignancies. This challenging surgery lasts between 4 to 10 hours, depending on the case’s complexity. Generally, a multidisciplinary approach is employed, involving an otolaryngologist and/or a plastic surgeon.
Surgeons who wish to advance their specialty may subspecialize in fields such as craniofacial surgery (cleft lip and palate restorations) and microvascular oncologic surgery (head and neck cancer surgery).
In cases of cleft lip and palate, patients and surgeons embark on a lengthy journey together. Patients undergo multiple surgeries throughout their lives. This path is both emotionally challenging and rewarding for the patients’ families and the surgeons.
Orthognathic surgery is another area of interest within the specialty. This procedure includes jaw surgeries aimed at correcting congenital (present from birth) and acquired facial deformities. Patients experience significant improvements in their facial structure and respiratory pathways. After the surgery, patients not only gain increased confidence in their appearance but also enjoy improved functions such as chewing, swallowing, and breathing.
In terms of compensation, OMFS ranks as the fifth highest-paying job according to usnews.com.
Private practice and academic surgery are the primary paths available for junior surgeons. In an office-based private practice, a surgeon might treat impacted wisdom teeth or perform bone grafts and dental implants. In a hospital setting, a surgeon might handle major cases like head, neck, or oral cancer, or perform cleft lip and palate surgery.
Furthermore, oral and maxillofacial surgeons working in hospitals often see patients who arrive at the emergency room with multi-system trauma.
Applicants aspiring to be the next generation of oral and maxillofacial surgeons must be enthusiastic about the field and committed to lifelong learning, as there are no boundaries to the science of OMFS. This pursuit requires considerable courage and sacrifice.
